Ground Glass Opacities and Mediastinal and Hilar Lymphadenopathy - 1290950

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adwoodworth
Ground Glass Opacities and Mediastinal and Hilar Lymphadenopathy - 1290950

Hello,

I am doing a little research to help my mother with her current health situation. I am seeking interpretation and possibly advice.

Mother, aged 84 and having suffered from a significant repiratory ailment a little over a year ago, was referred for diagnostic imaging. CT scan revealed numerous bilateral ground glass opacities (GGOs). Surveillance every 3 months suggested some growth in two of the larger nodules, both remain <5mm. Follow up was PET scan which showed some moderate FDG uptake in opacities with none identified as being primary. An unexpected result showed significant mediastinal lymph node and hilar lymph node uptake. Additional update was evident in parotid, identified as probable benign Warthin's tumor. Subsequent meeting with thoracic surgeon concluded with recommendation for further surveillance.

Medical history includes ongoing issues with irritable bowel syndrome (IBS), the onset of which was approximately a decade ago. In her youth, her roommate was taken to a sanitorium due to tuberculosis. She has some high blood pressure, but is otherwise unremarkable except for a recent history of skin cancer. Skin cancers included several basal cell carcinomas, treated by cryogenic and surgical removal, and a single squamous cell carcinoma, treeated with surgical removal and radiation. History of smoking (pack/day) from age 14-70. She has been a non-smoker for approximately 15 years. Currently asymptomatic except perhaps weakening of voice which may simply be age related. Also showing some minor nail clubbing.

At 84 years old, the doctor suggested no further action except to monitor the GGOs. Bronchoscopy or biopsy were ruled out as they would introduce unneccesary risk (a malignancy would necessitate chemotherapy but she is not a candidate due to age and the bilateral nature limits the viability of surgical resection).

Questions:

1. Possible benign causes?
2. Additional diagnostics?
3. Probable diagnosis?
4. Recommended actions?

catdander
"It’s very common to see

"It’s very common to see small lung nodules that are ambiguous in their significance, for which follow-up scans are typically recommended rather than diving into a biopsy, and non-solid, hazy GGOs are another form of lung lesion that might possibly represent a lung cancer but are also the way a little inflammation or small infection would appear. Even when they turn out to be something technically called cancer based on its appearance under the microscope, it’s often a non-invasive adenocarcinoma (sometimes termed bronchioloalveolar carcinoma, or BAC, but shifting in terminology to adenocarcinoma in situ, or AIS) or minimally invasive adenocarcinoma (MIA), in which the invasive component is less than 5 mm in diameter. Even when they grow, it can be at an extremely slow pace." http://cancergrace.org/lung/2013/04/13/follow-up-duration-for-ground-gla...

There's no standard timing for following with CT scans but 6 months more or less is usually used.
A nodule needs to be at least a cm to be reasonably hopeful of catching cancer cells, being hazy (not solid) the chances are less.

I hope this is helpful and I hope your mom never finds the need to biopsy.
All best,
Janine